Device for clamping organic tissue, in particular blood vessels

ABSTRACT

Device for clamping organic tissue, in particular blood vessels in minimal invasive surgery, with an application base for holding two clamping bars of absorbing material which, in their final position, are connectable to become a tissue clamp. The tissue clamp can be separated from the latter by means of an inner pusher.  
     The application base ( 2; 23 ) perpendicular to its longitudinal guide slot is equipped with two clamping bars and these can be merged to a tissue clamp. The application bar and clamping bars have guides, holders and fixatives which serve to precisely align the elements of the device and their unclamping.

The invention is for a device for clamping organic tissue, in particular blood vessels in accordance with the general term in patent claim 1, applicable in particular for minimal invasive surgery.

Such a device is already known from EP 0 178 469. This has a distal and proximal clamp bar which is vertical to the applicator base, whereby the proximal clamp bar is pushed in the direction of the distal clamping bar and the tissue can be clamped between them. The tissue clamp constructed in this manner can then be removed from the applicator base by means of a pusher surrounding the length of the applicator base, whereby a predetermined breaking point or a locking/unlocking device is attached to the applicator base or a basis of the distal clamping bar. The disadvantages of this device are in particular their complicated structure and their difficult handling. Above all the attaching of the applicator base with the clamp bar is difficult. It requires that the proximal clamp bar is always attached before the distal clamp bar. In addition, a securing fastening of the clamp bars to one another in their final position is hardly possible.

The invention is based on the task of creating a device such as described at the beginning which allows the precise holding and clamping of organic tissue, a variable equipping of the clamp bars in a simple manner, the design of the tissue clamp with little expense and can be used and produced inexpensively.

The invention solves the problem with a vertical holder on the distal end of the applicator base in which the first clamp bar is pushed vertically to the applicator base. At a distance from this in the direction of the base there is a second holder, parallel to the first and in which the second clamp bar can be vertically pushed along the applicator base. The two holders and the corresponding clamp bars are attached to holders and guides which serve to assure the pushing and attaching of the clamp bars. In addition, the two holders are connected to one another by means of a guideway along the axis of the applicator base, whereby along this guideway at least one of the clamp bars can be pushed to the other. For the exact pushing of the clamp bar within the guideway this and the clamp bar to be pushed must have at least one guiding device. With this it is possible it is possible to equip the device, i.e. its applicator base in the simplest manner possible with the two clamp bars and to make the tissue clamp by merging the two clamp bars. Then a holding device is attached to the clamp bars which aids in a precise approach of the clamp bars and allows their merging to a tissue clamp.

It is advantageous that the insertion or equipping and holding of the clamp bars into the holders or in the holders of the applicator base can be made force or form-fitting.

With little effort it is possible to insert and hold the clamp bars into the holders or in the holders for the most part force-fitting because the corresponding applicator base and the bases of the clamp bars are dimensioned in such a way that they function as a tight fits. Alone as a result of this it is possible on the one side that the second proximal clamp bar can be attached in the appropriate second proximal holder until it is pushed along the applicator base by means of the inner push. On the other side as a result the distal, first clamp bar can be held securely in the distal first holder until the two clamp bars are merged in the distal holder to the tissue clamp and pushed down from the applicator base by means of the inner push. The distance between the first distal holder always has to be equal or larger than the second proximal holder so that the proximal clamp bar can also pass by the distal holder when pushing the tissue clamp down the applicator base.

It is equally possible that the pushing in and holding of the clamp bars is also or exclusively form-fitting. For this the holders and clamp bars are provided with holders and guides so that an exact positioning of the clamp bars in the holders is guaranteed. The holders and guides are formed by at least one transverse slot within and perpendicular to the applicator base and at least one corresponding projection from the base belonging to the clamp bar. It may, however, also be that the projection of the holder of the applicator base and the traverse slot is attached to the base of the clamp bar.

In a simple and simultaneously effective manner, the position of the distal clamp bar to the applicator base can be secured in that the traverse slot of the distal holder is in the insertion direction of the first distal clamp bar and the projection of the clamp bar slips into the traverse slot force and form-fitting; the projection is shaped as a corresponding projecting shoulder from the base of the first clamp bar.

Both the attachment as well as the subsequent separation of the tissue clamp from the applicator base is promoted by the attachment shoulder being elastic and can therefore slip out of the traverse slot when attaining or surpassing the limit force required for separating the tissue clamp from the applicator base. The attachment shoulder stretches along the length inside the traverse slot.

The positioning of the clamp bar to the applicator base can also be benefit from the traverse slot and the attachment shoulder being placed on both sides of the first holder or base on the side facing the base.

The exact positioning and the moving of the second clamp bar can be attained easily and with high functionality by at least one of the traverse slots of the second clamp bar in the insertion direction is shaped as a guide-pin as the holder and guide of the second holder for the form-fitting intrusion of the corresponding projection ad projects from the base of the second clamp bar.

The positioning and moving can additionally be supported in that the one traverse slot is located on each side of the second holder, where the corresponding guide pins on the base of the clamp bar can enter. Hereby the traverse slots and the guide pins are to be dimensioned so that they fit together with almost no play and the vertical position of the clamp bar to the applicator base as well as the parallelity to one another is always guaranteed. The cross-section of the traverse slots and guide pins must correspond to one another. The cross-section of the guide pins is preferably round or rectangular and those of the traverse slot u-shaped.

In accordance with a special type it is intended that two traverse slots are placed on each side of the holders behind one another in the longitudinal direction of the applicator base and in each of the traverse slots a pair of corresponding guide pins behind one another slip in the insertion direction of the clamp bars. As a result on each side of the base of the clamp bars two pair of guide pins slip into the two traverse slots, whereby especially the exact positioning of the clamp bar in the holder or during its subsequent movement will be supported as soon as the two pairs of guide pins slip into the longitudinal slots of the guideway.

The exact moving of the clamp bars toward one another along the applicator base is made possible in a simple manner in that the guideway in the applicator base connecting the first and the second holder and the subsequent corresponding clamp bar is assigned a guideway direction. This is formed by at least a longitudinal slot and at least a corresponding projection or guide pi, which is either assigned to the applicator base or the clamp bar or its base.

Preferably the longitudinal slot of the guide slot of the applicator base and the corresponding projection or guide pin is assigned to the specific clamp bar. It my, however, be advantageous that the guide slot has the projection and the clamp bar the longitudinal slot.

The exact positioning and the moving of the clamp bar can also be improved by putting several longitudinal slots parallel to one another and across from one another within the guide slot intruding into the correspondingly located projections or guide pins of the clamp bar. The cross-section of the guide slot of the applicator base can then also have a T or double-T shape. In principle, the holders, clamp bars and the guide slot are to be dimensioned so that the tissue clamps from the individual clamp bars are pushed out of the guide slot in the longitudinal direction and separated from the applicator base. The width of the distal holder must therefore be at least equal to or larger than the width of the proximal holder. If the longitudinal slots of the guide slot of the applicator base do not continue to the distal end of the applicator base and perhaps only to the distal holder for the first clamp bar, which can be helpful for the exact positioning of the distal clamp bar in the associated holder, the guide pin or the projecting guide pins of the proximal clamp bar and, to the extent that these are present, those of the distal clamp bar have to be sheared off when pushing down the tissue clamp from the applicator base. This occurs with the proper dimensioning of the guide pins only after the required force for the unclamping of the tissue or remaining merger of the clamp bars is exceeded by the inner push. The shearing off of the guide pins described can be avoided or excluded if the longitudinal slot or slots of the guide slot leads past the distal holder up to the distal end of the applicator base. The shearing off of the guide pins can additionally be excluded by making the distance of the distal holder and the subsequent guide slots so large that the proximal clamp bars along with the projecting guide pins can pass through.

The traverse slots of the holders and the longitudinal slots of the guide slots merge into one another, but can also intersect with one another. As a result it is possible that the projections and guide pins of the base of the clamp bar which can be slid along the applicator base can enter or transfer to the guide and holder of the clamp bar as well as in the traverse slots of the holders and the longitudinal guides of the guide slot.

The invention also foresees that the attachment device is formed by a holding pin on the one clamp bar and a coaxial holder bore on the other clamp bar, whereby this runs lengthwise along the applicator base so that the attachment device is formed simply.

It is purposeful that the bases of the clamp bars are on the holding pins or the holding bore and this is formed with the corresponding traverse slot so that the attachment device can hardly come into contact with the tissue to be clamped. The holding pin and the holding bore have an overlapping which guarantees on the one side a sufficient parallelity of the clamp bars while clamping the tissue and on the other side allows for the certain force and/or form-fitting attachment in the final position. As a result a high degree of functionality is achieved with simple means.

It is, however, also purposeful if the clamp bars are not parallel, but slightly conical to one another so that when merging the clamp bars to the tissue clamp firstly the end away from the applicator base comes to the opposite enclosure and by proper deformation during the further merger of the clamp bars, these come to the opposite enclosure over a greater distance. The clamp bars are to some extent tensed against one another which can have a reducing effect on the clamping force on the tissue as a result of the dimensioning.

In another form it is planned that the cross-section of the holding pin and the corresponding holder bore have a shape geometric figures grouped around a central point or going into one another, whereby the interacting surfaces enlarges both and a form-fit closure is allowed in addition to the force-fit closure. A secure position of the clamp bars to one another can be significantly improved as a result.

In a simple manner the cross-section is shaped by three overlapping circles around a central point forming a star, so that the long edges are formed along the holding pin which favors an attachment of the same in the holding bore.

Further properties of the inventions and its advantages can be taken from the remaining description and the patent claim.

The invention is to be explained in greater detail by means of several sample executions. The corresponding sketches show the schematic and enlarger illustration:

FIG. 1: front view of device in partial and partial cross-section presentation,

FIG. 2: top view of an applicator base as per FIG. 1, in partial presentation,

FIG. 3: front view of a distal clamp bar as per FIG. 1,

FIG. 4: side view of the clamp bar as per FIG. 3,

FIG. 5: front view of a proximal clamp bar as per FIG. 1,

FIG. 6: top view of the clamp bar as per FIG. 5,

FIG. 7: front view of another execution of the device, in partial and parital cross-section presentation,

FIG. 8: top view of an applicator base as per FIG. 7, in partial presentation,

FIG. 9: front view of a distal clamp bar as per FIG. 7,

FIG. 10: side view of the clamp bar as per FIG. 9,

FIG. 11: top view of the clamp bar as per FIG. 11,

FIG. 12: cross-section A-A as per FIG. 2,

FIG. 13: cross-section of another execution of a device

The device 1 for clamping organic tissue, in particular blood vessels (FIG. 1) has an applicator base 2, which stretches distally along a proximal base which is not described in greater detail. With the base the applicator base 2 is also connected to an application instrument which is not described in further detail. Within the applicator base 2 an inner pusher 3 can be pushed essentially along the entire length of the guide slot 4 of the applicator base 2 by means of the application instrument, whereby the guide slot 4 stretches on the opposite side of the application instrument from its distal end 5 up to its proximal end. The ends 5 and 6 each have clamp bars 7, 8, between which their clamp bases 9 can clamp off the blood vessel. The clamp bars 7, 8 reach from bases 10, 11 in such a manner that the clamp bases 9 are always vertical to the applicator base 2 and parallel to one another. It is, however, also possible that the clamp bars 7, 8 and their clamp bases 9 are slightly conical to one another and to some extent are pre-stressed is such a manner that when merging the clamp bars 7, 8 first their areas away from the applicator base 2 come to the opposite piece and only after wards do the other clamp bases 9 approach one another.

The distal end 5 of the guide slot 4 is on a holder 12 (FIG. 2) in which the base 10 of the first distal clamp bar 7 can be inserted vertically to the applicator base 2. A second proximal holder 13 is on the proximal end 6 of the guide slot 4; the second proximal clamp bar 8 can be inserted vertically to this. The holders 12, 13 differ from the other guide slot 4 in that the clamp bars clamp bars 7, 8 can also be attached in them, while only guide slot 4 serves as the guide of the proximal clamp bar 8 to the distal clamp bar 7. Although it could be sufficient to attach the clamp bars 7, 8 within the holders 12, 13 by pressing or transition fitting of the interacting surfaces of the guide slot 4 and the bases 10, 11 primarily by means of force closing, the holders 12, 13 and the bases 10, 11 have holders and/or guides which guarantee the secure and exact positioning on the one side during the loading of the applicator base 2 and on the other side during the reciprocal moving of the clamp bars 7, 8 alone or in addition to the form fit.

The holders and guides are, on the one side, formed from at least one traverse slot 14 (FIG. 2) of the holder 12, 13. On the other side at least one corresponding projection to traverse slot 14 is planned which is shaped as a guide pin 15 and on the clamp bars 7, 8. On device 1 there are two of the guide pins 15 on each side of bases 10, 11 (FIGS. 1, 3, 4, 5, 6); the pins are behind one another in the insertion direction of the clamp bars 7, 8, standing out from the bases 10, 11 and enter one after the other into the corresponding traverse slot 14 as soon as clamp bars 7, 8 is inserted into applicator base 2 or applicator base 2 is equipped with clamp bars 7, 8. the guide pins 15 and traverse slots 14 are correspondingly shaped in such a way that the guide pins 15 are inserted into traverse slot 14 with almost no play and are held so that the essentially vertical position of the clamp bars 7, 8 to the applicator base 2 is always assured.

In a device 16 in accordance with FIGS. 7 and 8, the holders and guides of a distal holder 17 of an applicator base 23 and a base 18 of a clamp bar 18 on the one side are formed by a traverse slot 20 and on the other by a projection made of the projecting attachment shoulder 21 (FIGS. 9, 10,11). The attachment shoulder 21 l on the proximal side of holder 17 at a right angle to the applicator base 23 and slipss in its entire length in the corresponding traverse slot 20. it is elastic and dimensioned so that on the one side it attaches the distal clamp bar 19 securely in holder 17, on the other side, however, sticks out of the traverse slot 20 and the clamp bar 19 is released from the holder 17 as soon as the merger of the tissue clamp is concluded by means of the inner push 3 and the push pressure has attained a defined value with which the tissue clamp is pushed out of the guide slot 24 in the longitudinal direction of an applicator base 23 and separated from the applicator base 23. a proximal clamp bar 25 of device 16 differs from the one described above in that on each side of a base 26 a total of four guide pins 15 (FIG. 7) stand out which in pairs slip into two parallel traverse slots 14 of a holder 27.

The holders 12, 13 and 17, 27 are connected with one another by means of the guide slot 4 and 24 so that the proximal clamp bars 8 or 25 are pushed along the guide slot 4 or 24 to the distal clamp bars 7 or 19 and the two can be connected to clamp off a blood vessel and to form the tissue clamp. The guide slots 4, 24 and the bases 11 or 26 of the clamp bar 8 or 25 have at least one guide device which serves to precisely position the clamp bars 8, 25 while it is being pushed along the applicator base 2, 23. The guide device is formed on the one side by at least one longitudinal slot 28, which stretches along the guide slot 4, 24 and on the other side by at least on of the guide pins 15 rising up out of the base 11, 26. When moving the clamp bars 8, 25 along the applicator base 2, 23 the guide pin 15 or guide pins 15 go from the traverse slot 14 into the longitudinal slot 28. This is possible because longitudinal slot 28 mouths in the holders 12, 13, 20, 27 and crosses these.

In every side wall of the guide slot 4, 24 there may be one, two or more parallel longitudinal slots 28 so that the cross-section of the guide slot 4, 24 may be, for example, T or double-T shaped. With the double-T shaped cross-section (FIG. 12) the positioning of the clamp bars 8, 25 can be improved in that two pairs of guide pins 15 rise next to and on top of each side of the bases 11, 26 and slip as pairs into the specific longitudinal slot 28.

In accordance with the special execution in accordance with FIG. 13 the guide device may also be formed by at least one longitudinal slot 29 in a base 30 of a clamp bar 31 and at least on projecting base 32 which stretches along a guide slot 33 above the same in the guide slot 33. in this case an applicator base 34 is not for-shaped, but rather is preferably equipped with a base plate. The base 29 can be leaned against this when equipping the applicator base 34 and inserting at least on proximal clamp bar 31 and positioned in such a way that the base 32 can slip securely into longitudinal slot 29 when being moving the clamp bar 31 along the guide slot 33. Preferably both the longitudinal slot 29 and the base 32 on the other side will be paired (FIG. 13).

In accordance with another design it is additionally possible that the guide slot 33 is used for equipping the applicator base 34 with the proximal clamp bar 31 and the incorporation such as the proximal holders 13 can be avoided. In this case the upper portions of the applicator base 34 can be bent away from each other when inserting the clamp bar 31 that first the base 29 goes between the bases and at the end of the equipping of the base 32 jumps in the longitudinal slots 29 and then the clamp bar 31 can be pushed within the guide slot 33. In this way it is then also possible to put the base 32, which may also be shaped as one or more guide pins 15 in the longitudinal direction of the applicator base 34, on the clamp bar 31 and the guide slot 33 to the applicator base 34.

While the clamp bars 7, 8, 19, 25, 31 are shaped in various ways and they can be assigned to various corresponding holders and guides, they have in common that each pair of clamp bars 7, 8, 19, 25, 31 have an attaching device which essentially consists of a holding pin 36 and a correspondingly shaped and coaxially placed holding bore 37 this attachment device serves on the one hand to position the corresponding two clamp bars 7, 8, 19, 25 in the final phase of their approach to one another and, on the other hand, to achieve their permanent connection to their final position to the tissue clamp. The holding pin 36 and the holding bore 37 are located on bases 10, 11, 18, 26, 30 so that they are outside of the actual clamping area and hardly come into contact with the tissue to be clamped off. The axial extension of these and the resultant length of the overlapping which also depends on the thickness of the tissue to be clamed off is to be dimensioned so that a precise positioning and permanent connection results. Both show corresponding cross-sections which allow for force- and form-fitting interaction. This is achieved in that their cross-section is formed by geometric figures placed around their joint axis in a star-shape, for instance, three overlapping circles. Any other cross-section is, however, also conceivable as long as it allows the force- and/or form-fitting. The cross-sections of the holding pin 36 and the holding bore 37 may, correspondingly, be shaped like pyramids, cones or ellipses.

The distal front of the inner push 3 and the opposite proximal front surface of the bases 11, 26, of the proximal clamp bars 8, 28 are correspondingly profiled. While the inner push 3 has a centering pin 39, the bases 11, 26 have a corresponding centering bore 40, whereby it is also possible for the centering pin 39 to be on the bases 11, 26 and the centering bore 40 to be on the inner push 3. As a result of the meshing of the two the guiding or positions of the proximal clamp bars 8, 25 can be essentially improved while they are being moved along the applicator base 2, 23.

The clamping off of the tissue by means of device 1, 16 occurs as follows. The applicator base 2, 23 is equipped with the clamp bars 7, 8, 19, 25 in that firstly the distal clamp bars 8, 25 are inserted vertically in the distal holder 12, 17 and then the proximal clamp bars 8, 25 are inserted in the proximal holders 13, 27. In this way the guide pin 15 or the attachment shoulder 21 slid into the traverse slots 14 or 20. Then the proximal clamp bars 8, 25 are pushed by the inner push 3 so far in the direction of the distal clam bars 8, 19 that their bases 11, 26 enter into the guide slots 4, 24 and the guide pins 15 enter into the longitudinal slot 28 or longitudinal slots 28 of the guide slots 4, 24. Thereafter, the applicator bases 2, 23 equipped with the clamp bars 7, 8, 19, 25 are led to the operation area by means of a trocar (not shown). There the tissue to be clamped off is caught between the two clamp bars 7, 8 or 19, 25. Then the proximal clamp bars 8, 25 are pushed further in the direction of the distal clamp bars 7, 19 by means of the inner push 3 until both are permanently connected to the tissue clamp in their final position and the tissue between them is clamped off. When the final position is reached the holding pin 36 enters into the holding re with a force- and/or form-fitting connection. Then the tissue clamp is pushed down the applicator base 2, 23 by means of the inner push 3 and separated from this. The guide pins 15 on the distal side of the distal holder 12, 17 are sheared off from the bases 10, 11, 18, 26 or the attachment shoulder 21 comes out of the traverse slot 20 as soon as the force exerted by the inner push exceeds the value required for merging the clamp bars 7, 8, 19, 25. the applicator base 2, 23 can then be removed from the operation area and pulled out of the trocar.

The shearing off of the projecting pins 15 occurs because the longitudinal slots 28 mouth in the distal holder 13, 18 and do not continue up to the distal front side of the applicator base 2, 23. In this case, as in the execution example according to FIG. 1, the attachment of the distal clamp bar 7 is significantly supported by the projecting pins 15. By means of corresponding dimensioning of the guide pins, the shearing off happens only after the tissue is clamped off and the force required by the inner push for the remaining merger of the clamp bars 7, 8 is exceeded. The shearing of the guide pins 15 described may, however, also be avoided or excluded if the longitudinal slot 28 or longitudinal slots 28 of the guide slot 4 extend beyond the distal holder 12 up to the distal end 5 of the applicator base 2 and the guide pins can exit from the applicator base 2 in these. The shearing off of the guide pins may also be excluded in that the distance of the distal holder 12 and the subsequent guide slot 4 is so large that the proximal clamp bar 8 can also fit through along with the projecting guide pins 15.

Especially with the execution example according to FIGS. 7 and 8 it is possible that the longitudinal slots 28 can be continued up to the distal front of the applicator base 24 and therefore exclude a shearing of the guide pins of the proximal clamp bar 25, the secure attachment of the distal clamp bar 19 is here, however, primarily as a result of the attachment shoulder 21 and the corresponding traverse slot 20.

LIST OF DRAWING REFERENCES

-   1. Device -   2. Applicator base -   3. Inner push -   4. Guide slot -   5. End -   6. End -   7. Clamp bar -   8. Clamp bar -   9. Clamp base -   10. Base -   11. Base -   12. Holder -   13. Holder -   14. Traverse slot -   15. Guide pin -   16. Device -   17. Holder -   18. Base -   19. Clamp bar -   20. Traverse slot -   21. Attachment shoulder -   23. Applicator base -   24. Guide slot -   25. Clamp bar -   26. Base -   27. Holder -   28. Longitudinal slot -   29. Longitudinal slot -   30. Base -   31. Clamp bar -   32. Bar -   33. Guide slot -   34. Applicator base -   35. Base plate -   36. Holding pin -   37. Holding bore -   38. Axis -   39. Centering pin -   40. Centering bore 

1. Device for clamping organic tissue, in particular blood vessels with a base plate, that is attached in a removable manner to the distal end of an application instrument and from which an applicator base stretches out distally in which a inner pusher can be shoved lengthwise, whereby the clamping bars primarily vertical to the applicator base are of absorbing material and can be pushed toward one another from the initial position, where they have a large distance from one another, to the final position, where they are close to one another and, wherein, the applicator base (2; 23) has a first holder (12; 17) on its distal end (5), wherein perpendicular to the applicator base (2; 23) the first clamp bar (7; 19) can be inserted and at a distance from this the second clamp bar (8; 25) can be inserted perpendicularly to the applicator base (2; 23), whereby the two holders (12; 13; 17; 27) as well as the corresponding clamp bars (7; 8; 19; 25) have holders and/or guides which connect the holders (12; 13; 17; 27) by means of a guide slot (4; 24) running the length of the applicator base (2; 23), whereby the guide slot (4; 24) and at least one of the 7xa has at least guide device by means of which the mutual mobility of the clamp bars (7; 8; 19; 25) is assured while continuously maintaining the opposite orientation to one another and the clamp bars (7; 8; 19; 25) have an attachment device to attach themselves in their final position.
 2. Device in accordance with claim 1, wherein the inserting and holding of the clamp bars (7; 8; 19; 25) into or within the holders (12; 13; 17; 27) of the applicator base (2; 23) is force- and form-fitting.
 3. Device in accordance with claim 1, wherein the inserting and holding of the clamp bars (7; 8; 19; 25) is primarily by force-fitting and the holding and/or guiding is formed by the dimensioning of the corresponding areas of the holders (12; 13; 17; 27) of the applicator base (2; 23) and the bases (10; 11; 18; 26) of the clamp bars (7; 8; 19; 25) as a press fit.
 4. Device in accordance with claim 1, by wherein the inserting and holding of the clamp bars (7; 8; 19; 25) is primarily by force-fitting and the holding and/or guiding of the holders (12; 13; 17; 27) and the clamp bars (7; 8; 19; 25) is formed by at least one traverse slot (14; 20) within and perpendicular to the applicator base (2; 23) and at least one corresponding projection rising from a base (10; 11; 18; 26) of the clamp bars (7; 8; 19; 25).
 5. Device in accordance with claim 1, wherein projection of the holders (12; 13; 17; 27) is located on the applicator base (2; 23) and the traverse slot (14; 20) on the bases (10; 11; 18; 26) of the clamp bars (7; 8; 19; 25).
 6. Device in accordance with claim 1, wherein the traverse slot (20) of the distal holder (17) is in the direction of the fist clamp bar (19) and a corresponding projection is on this which is formed as a projecting attachment shoulder (21) from the base (18).
 7. Device in accordance with claim 1, wherein an attachment shoulder runs along the traverse slot (20) and is elastic in such a way that when moving the clamp bar (19) toward the applicator base (23) and that it exits from the traverse slot (20) when the force limit for the separation of the tissue clamp of the applicator base (23) and the tissue clamp can be moved along the applicator base (23).
 8. Device in accordance with claim 1, comprising the traverse slot (20) and the attachment shoulder (21) being on both sides of the distal first holder (17) on the side closer to the base.
 9. Device in accordance with claim 1, wherein at least one traverse slot (14) in the insertion direction of the clamp bars (7; 8;25) projects as holder and guide of the holders (12; 13; 27) for the form-fit insertion in the projection which projects as corresponding guide pin (15) from the bases (10; 11; 26) of the clamp bars (7; 8; 25).
 10. Device in accordance with claim 1, wherein one of the traverse slots (14) is foreseen on each side of the holders (12; 13; 27) which can slip into the corresponding guide pins (15) on either side of the bases (10; 11; 26) of the clamp bars (7; 8; 25).
 11. Device in accordance with claim 1, wherein two of the traverse slots (14) are located one behind the other on both sides in the longitudinal direction of the applicator base (2; 23) and in each of the guide slots (4; 24) a pair of corresponding guide pins (15) slip into the insertion direction of the clamp bars (7; 8; 25) one behind the other.
 12. Device in accordance with claim 1, wherein the guide slot (4; 24) connecting the first and second holders (12; 13; 17; 27) have a guiding device to take up and guide the clamp bar (8; 25) while it is moving along the applicator base (2; 23).
 13. Device in accordance with claim 1, comprising the guide device having at least one longitudinal slot (28) and at least one corresponding projection to this is formed that located such that it is either for the applicator base (2; 23) or the clamp bar (8; 25).
 14. Device in accordance with claim 1, comprising the longitudinal slot 28 being in the guide slot (4; 24) of the applicator base (2; 23) and the corresponding projection projects from the base (11; 26) of the clamp bar (8; 25).
 15. Device in accordance with claim 1, comprising there being several longitudinal slots (28) of which the cross-section of the guide slot (4; 24) of the applicator base (2; 23) having a T or double T-shaped form into which the corresponding projections from the base (11; 26) of the clamp bar (8; 25) slip.
 16. Device in accordance with claim 1, wherein at least one projection projects from the guide slot (4; 24) and a corresponding longitudinal slot 28 stretches along the base (11; 26) of the clamp bar (8; 25).
 17. Device in accordance with claim 1, wherein a guide in an applicator base (34) is formed by at least one base (32) and a corresponding longitudinal slot (29) which stretches along the applicator base (34) and is allocated to either a guide slot (33) of the applicator base (34) or a base of a clamp bar (31).
 18. Device in accordance with claim 1, wherein the base (32) of the applicator base (34) stretches into the guide slot (33) and slips into the longitudinal slot (29) of the base (30).
 19. Device in accordance with claim 1, wherein the base (32) and the longitudinal slot (29) located together on both sides of the applicator base (34) or base (30) and the applicator base (34) can be spread out to equip it with the clamp bar (31) until the base (30) is taken up in the guide slot (33) and the base (32) enters into the longitudinal slot (29).
 20. Device in accordance with claim 1, wherein the holder (12; 13), the clamp bars (7; 8; 19; 25), traverse slot (14), guide slot (4; 24) and longitudinal slot (28) are dimensioned so that the tissue clamp can be pushed distally from the applicator base (2; 23) by means of the inner push (3) after reaching the final position.
 21. Device in accordance with claim 1, comprising the attachment device being formed by a holding pin (36) and coaxial bore (37) that runs coaxially the length of the applicator base (2; 23) and is on either the one or the other clamp bars (7; 8; 19; 25).
 22. Device in accordance with claim 1, wherein the holding pin (36) and the holding bore (37) are located on the bases (10; 11; 18; 26) of the clamp bars (7; 8; 19; 25), these formed with corresponding cross-section and an overlapping of such that they are parallel to the clamp bars (7; 8; 19; 25) during the clamping of the tissue and also they are securely fastened in the final position both force and form-fitting.
 23. Device in accordance with claim 1, wherein the cross-section shows the form of geometric figures crossing over and merging with one another around a central axis (38).
 24. Device in accordance with claim 1, comprising the cross-section being formed by overlapping circles forming a star around an axis (38).
 25. Device in accordance with claim 1, comprising the holding pin (36) and the holding bore (37) being shaped correspondingly either as pyramids, cones, or cylinders.
 26. Device in accordance with claim 1, comprising the clamp bars (7; 8; 19; 25) being slightly conical and pre-stressed toward one another 50 that they have a greater distance to one another near the applicator base (2; 23) than they do farther away from it.
 27. Device in accordance with claim 1, by wherein the distal front surface of the inner push (3) and the proximal front surface of the base (11; 26) of the clamp bar (8; 25) have corresponding profiles.
 28. Device in accordance with claim 1, wherein the profiles are shaped by a centering pin (39) and a centering bore (40) that is located either on the base (11; 26) or the inner push (3). 